肝细胞癌的临床概况和治疗：单中心经验

StephenW

肝细胞癌的临床概况和治疗：单中心经验
Abu B H Bhatti 1、Abdul A E Sheikh 1、Umair S Mahmud 1、Shagufta Zeeshan 1、Nusrat Y Khan 1、Haseeb H Zia 1、Faisal S Dar 1、Atif Rana 2
隶属关系
隶属关系

    1
    巴基斯坦伊斯兰堡什法国际医院肝-胰-胆外科和肝移植科。
    2
    巴基斯坦伊斯兰堡什法国际医院放射科。

    PMID：34568219 PMCID：PMC8460341 DOI：10.1055/s-0041-1729451

抽象的

背景 巴基斯坦很少有中心能够在一个屋檐下提供所有已建立的肝细胞癌 (HCC) 治疗方法。我们拥有专门的肝胰胆外科和肝移植科室，收集了我们人群中最大的 HCC 数据之一。目的 本研究的目的是评估巴基斯坦患者的 HCC 临床谱。设置和设计 本次对诊断为 HCC 的患者的回顾性审查是在 2011 年至 2016 年期间进行的。 材料和方法 根据巴塞罗那诊所肝癌 (BCLC) 分期算法和我们当地的指南，将患者分配到治疗组。治疗方案分为治愈性（射频消融 [RFA]、经皮乙醇注射 [PEI]、肝切除术和肝移植）、姑息性（经动脉化疗栓塞 [TACE]/索拉非尼）和最佳支持治疗 (BSC)。统计分析 Kaplan-Meier 曲线用于统计分析。结果 平均年龄为 57.9 ± 10.1 岁（范围：18-90 岁）。男女比例为 (1,099/391) 2.8:1。在 1,490 名患者中的 1,350 名 (90.6%) 患者中，乙型肝炎和丙型肝炎是最常见的潜在病因。 1,490 名患者中有 492 名 (33%) 出现大血管侵犯 (MVI)。在总数中，与 BCLC 建议相比，另外 191 (12.8%) 名患者获得了潜在的治愈性治疗。接受肝移植、RFA/PEI、TACE、索拉非尼和 BSC 的患者的精算 5 年总生存率分别为 87、64、18、5 和 0%。无论接受何种治疗，400 ng/mL 的甲胎蛋白临界值对生存率都有显着影响（41% vs. 11%，p < 0.0001）。结论 MVI 是 HCC 患者中最常见的不良预后标志物。当地治疗指南可有效产生与 BCLC 相当的结果。

关键词：巴塞罗那诊所肝癌分期；肝细胞癌;肝移植；经动脉化疗栓塞。

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StephenW

Clinical Profile and Treatment of Hepatocellular Carcinoma: A Single-Center Experience
Abu B H Bhatti  1 , Abdul A E Sheikh  1 , Umair S Mahmud  1 , Shagufta Zeeshan  1 , Nusrat Y Khan  1 , Haseeb H Zia  1 , Faisal S Dar  1 , Atif Rana  2
Affiliations
Affiliations

    1
    Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
    2
    Department of Radiology, Shifa International Hospital, Islamabad, Pakistan.

    PMID: 34568219 PMCID: PMC8460341 DOI: 10.1055/s-0041-1729451

Abstract

Background Very few centers in Pakistan have all established treatments for hepatocellular carcinoma (HCC) available under one roof. With a dedicated hepato-pancreato-biliary surgery and liver transplant unit, we have gathered one of the largest data on HCC in our population. Aims The objective of the current study was to assess the clinical spectrum of HCC in Pakistani patients. Settings and Design This retrospective review of patients diagnosed with HCC was conducted between 2011 and 2016. Materials and Methods Patients were allocated to treatment groups based on the Barcelona clinic liver cancer (BCLC) staging algorithm and our local guidelines. The treatment options were grouped as curative (radiofrequency ablation [RFA], percutaneous ethanol injection [PEI], liver resection, and liver transplantation), palliative (transarterial chemoembolization [TACE]/sorafenib), and the best supportive care (BSC). Statistical Analysis Kaplan-Meier curves were used for the statistical analysis. Results The mean age was 57.9 ± 10.1 years (range: 18-90 years). The male-to-female ratio was (1,099/391) 2.8:1. Hepatitis B and hepatitis C were the most common underlying etiological factor in 1,350 of 1,490 (90.6%) patients. Macrovascular invasion (MVI) was seen in 492 of 1,490 (33%) patients. Out of the total, 191 (12.8%) additional patients were offered potentially curative treatments when compared with BCLC recommendations. The actuarial 5-year overall survival for patients who underwent liver transplant, RFA/PEI, TACE, sorafenib, and BSC was 87, 64, 18, 5, and 0%, respectively. Alpha fetoprotein cut-off of 400 ng/mL had a significant impact on survival irrespective of treatment received (41 vs. 11%, p < 0.0001). Conclusion MVI is the most frequent poor prognostic marker in our patients with HCC. Local treatment guidelines are effective in yielding comparable outcomes to BCLC.

Keywords: Barcelona clinic liver cancer staging; hepatocellular carcinoma; liver transplantation; transarterial chemoembolization.

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StephenW

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